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- Eriksson, Mats, 1959-
(författare)
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Aspects of prevention and assessment of neonatal pain
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Improvements in neonatal care have led to improved mortality and morbidity rates. An increased number of infants that are born more prematurely are being treated for prolonged time periods in the neonatal care units. The care includes many procedures that might inflict pain on the newborn infants. Pain is a protective mechanism, but it can have negative short- and long-term consequences on vulnerable infants. In order to prevent and treat pain, reliable pain assessment is needed. The aim of this research was to improve pain relief at blood sampling in the neonatal period, by non-pharmacological methods, and to investigate skin conductance as a pain assessment tool in newborn infants.Study I was a randomised trial with 120 infants divided into four groups, who received 1 ml 10% glucose, 30% glucose, breast milk or no solution, orally, two minutes prior to the heel-stick. In the group given 30% glucose the crying time was significantly shorter than in the control group. Significantly fewer infants in the 30% glucose group did not cry at all, and the heart rate increased less in that group than in the control group.Study II was a randomised trial with 120 infants divided into four groups, undergoing blood sampling with either heel-stick or veneplmcture and receiving 1 ml 30% glucose orally, or no fluid, prior to the painful event. The crying time was significantly shorter and PIPP pain score lower in the venepuncture group than in the heel-stick group when no glucose was given. When glucose was given, PIPP score was lower in both glucose groups than in the groups without glucose, but no difference was seen between the two glucose groups. Crying time in the glucose group was shorter than ill the group without glucose when heel-stick was performed.In study III we used a randomised controlled double-blind design. Two hundred and one infants were randomly allocated to one of two groups receiving either 0.5 g EMLA® on the dorsum ofthehandfor 60 minutes followed by a recovery period of 15 min, and 1 ml sterile water in the mouth 2 min prior to venepuncture, or 0.5 ml placebo cream on the hand and 1 ml 30% glucose orally. PIPP scores were lower in the glucose group and fewer infants were scored as having pain (PIPP > 6). Crying time during the first 3 ruin was shorter in the glucose group.Study IV was designed in a randomised, controlled double-blind way, where 57 infants were divided into two groups, receiving either 1 ml sterile water or 30% glucose three times daily for 3-5 days. Before undergoing routine blood sampling all infants had 1 ml 30% glucose instilled in the mouth. There was no difference in PIPP score, crying time or heart rate increase between the groups.In study V galvanic skin response and other pain assessment methods were investigated in 32 infants during three procedures performed in a randomised order: 1) gently touching an ann or a leg (no stress or pain), 2) putting a alcohol-soaked cloth on the tnmk skin (stress) and 3) performing heel-stick for routine blood sampling (pain). GSR conductance level increased more in the painful than in the stressing situation. Number of waves and amplitude of the waves increased more during pain than during touching. Crying time was higher dming the painful situation than during the stressful intervention and PIPP was higher during pain than during touching and stress.In conclusion, we found that 1 ml 30% glucose reduces pain signs from heel-stick and from venepuncture in neonates. Glucose does this better than EMLA ® cream and the effect is better than that of changing from heel-stick to venepuncture. Repeated administration of 1 ml 30% glucose for 3-5 days does not decrease the pain relieving effect.GSR can contribute to differentiate pain from stress but more research is needed to achieve a clinically useful application.
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| 2. |
- Flacking, Renée, et al.
(författare)
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Long-term duration of breastfeeding in Swedish low birth weight infants
- 2003
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Ingår i: Journal of Human Lactation. - : SAGE Publications. - 0890-3344 .- 1552-5732. ; 19:2, s. 157-165
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to describe the long-term incidence of breastfeeding in a geographically defined cohort of low birth weight (LBW) (< 2500 g) Swedish infants (N = 70) at discharge from a neonatal unit and at the postnatal ages of 2, 4, 6, and 8 months. The infants' breastfeeding data were examined retrospectively and compared to annual breastfeeding data for all infants born in the same year and county (N = 2,751). Ninety-three percent of the LBW infants were fed breast milk at discharge and 36% at 6 months, compared to 97% and 75%, respectively, of the county population. Cox regression analysis showed that multiparity was a significant predictor associated with shorter breastfeeding in LBW infants (odds ratio = 2.51. 95% confidence interval, 1.35-4.69). LBW infants had a high breastfeeding incidence but a significantly shorter duration than controls. This result indicates the need for intensified support throughout the breastfeeding period.
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| 3. |
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| 4. |
- Naver, Lars, et al.
(författare)
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Appropriate prophylaxis with restrictive palivizumab regimen in preterm children in Sweden
- 2004
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 93:11, s. 1470-1473
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- AIM: Palivizumab (Synagis) was registered in Sweden in 1999 for prophylaxis against respiratory syncytial virus (RSV) in premature infants. The high costs and the limited knowledge of the efficacy of this substance have led to debate about how and when it should be used. National guidelines for the use of palivizumab in Sweden were constructed in the year 2000. The aim of this study was to evaluate the guidelines. METHODS: A nation-wide prospective study was conducted during the two RSV seasons of the years 2000-2002. The paediatric departments in Sweden reported the use of palivizumab, the indication for its use, and the number of infants born preterm before 36 wk of gestation and less than 2 y old who were admitted to hospital for RSV infection. RESULTS: During the two seasons, 218 (3.8%) children who were born before 36 wk of gestation, and 97 (5.4%) who were born before 33 wk, were hospitalized because of RSV infection. Five children were treated with mechanical ventilation. No death caused by RSV was reported. A total of 390 children were treated with palivizumab, and 16 (4.1%) of those who received prophylactic treatment were admitted to hospital with RSV infection. CONCLUSION: We consider the comparatively restrictive Swedish recommendations to be safe and recommend that palivizumab should also be used very restrictively in the future. In our opinion, palivizumab in preterm children could be recommended only for those with chronic lung disease younger than 1 y of age, and with active treatment for their disease.
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| 5. |
- Navér, Lars, et al.
(författare)
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Profylax mot RS-virusinfektion
- 2002
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 99, s. 170-171
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 6. |
- Wallin, Lars
(författare)
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Knowledge Utilisation in Swedish Neonatal Nursing : Studies on Guideline Implementation, Change Processes and Contextual Factors
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to study the implementation of guidelines, change processes and contextual variables from the perspective of improvements and neonatal nursing care’s endeavours to be more evidenced-based. Because health care is exposed to extensive change pressure and because the impact of effectiveness research on clinical practice is limited, it becomes urgent to understand how knowledge utilisation initiatives can be facilitated.Three studies involved managers and nurses at all neonatal units in Sweden. Two of these studies also included nurses from other healthcare organisations. The fourth study included all staff at four neonatal units. The study designs used were cross-sectional, comparative and prospective longitudinal surveys; questionnaires were used as data collection tools in all four studies.Evaluation of the utilisation of the neonatal nursing guidelines showed that the guidelines were known to the nurse managers and used at most of the units, though to varying degrees and in different ways. Fifteen months after guideline dissemination, 8 of 35 units had changed practice, of which 2 units had completed the implementation process of a guideline. Involvement in the preceding guideline project facilitated the completion of improvement projects compared with participation in training courses for quality improvement (QI) only. There was no difference between these two groups on long-standing involvement in improvement work. Nurses who continued QI work over a 4-year period were more active in seeking research and implementing research findings in clinical practice than those who ceased the improvement work. The QI-sustainable nurses reported better contextual support for research-related activities. In a separate study staff perceptions of organisational factors appeared stable over the course of one year at the aggregated level. Improvements in skills development and participatory management predicted higher overall organisational and staff well-being. The findings emphasize the importance of including both individual and organisational factors in the strategic planning for evidence-based nursing. Plans have to be long-term and consider that change is a slow process. Leadership commitment is essential and there are clear benefits in developing a learning and professional supportive environment as well as of involving staff in organisational decision making.
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